Continued Improved Wear with an Annealed Highly Cross-linked Polyethylene (original) (raw)
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The Journal of Hip Surgery
First-generation highly crosslinked polyethylene (HXLPE) was developed to reduce polyethylene wear debris and subsequent osteolysis. Two thermal stabilization strategies were developed, annealing and remelting, to remove free radicals remaining in the polymer. Both types of HXLPEs have demonstrated better wear resistance to conventional polyethylene in hip arthroplasty. However, few studies have directly compared the mid- to long-term clinical outcomes of first-generation HXLPEs. We sought to address the following research questions: (1) is there a difference between the revision reasons for HXLPE formulations (annealed and remelted), (2) is there a difference in oxidation between annealed and remelted HXLPEs, (3) is there a difference in the linear penetration rate of annealed and remelted HXLPEs, and (4) does the formulation of first-generation HXLPEs affect the prevalence of osteolysis? A total of 129 first-generation HXLPE acetabular liners were collected in a multicenter retrie...
Clinical Orthopaedics & Related Research, 2015
Background Patients 50 years or younger are at high risk for wear-related complications of their total hip arthroplasty (THA) because of their generally higher levels of activity. Highly crosslinked polyethylene (HXLPE) is believed to be more durable for this population than conventional polyethylene because of its improved wear; however, limited information is available on the wear of HXLPE in this population, particularly the wear of HXLPE when it articulates with alternative bearings like Oxinium (Smith & Nephew, Memphis, TN, USA).
Clinical Orthopaedics and Related Research®, 2010
Background First-generation highly cross-linked polyethylene liners have reduced the incidence of wear particleinduced osteolysis. However, failed acetabular liners have shown evidence of surface cracking, mechanical failure, and oxidative damage. This has led to the development of second-generation highly cross-linked polyethylene, which has improved wear and mechanical properties and resistance to oxidation in vitro. Owing to its recent introduction, there are no publications describing its clinical performance. Questions/purposes We assessed early clinical wear of a second-generation highly cross-linked polyethylene liner and compared its clinical performance with the published results of hip simulator tests and with first-generation highly cross-linked polyethylene annealed liners. Patients and Methods Twenty-one patients were enrolled in a prospective cohort study. Clinical outcome and femoral head penetration were measured for 19 patients at 6 months and 1 and 2 years postoperatively. Results The median proximal head penetration was 0.009 mm and 0.024 mm at 1 and 2 years, respectively. The median two-dimensional (2-D) head penetration was 0.083 mm and 0.060 mm at 1 and 2 years, respectively. The median proximal wear rate between 1 and 2 years was 0.015 mm/year. Conclusions The wear rate calculated was similar to the in vitro wear rate reported for this material; however, it was less than the detection threshold for this technique. Although longer followup is required for wear to reach a clinically quantifiable level, this low level of wear is encouraging for the future clinical performance of this material.
The Journal of Arthroplasty, 2012
The purpose of this study was to analyze wear rates of highly cross-linked polyethylene comparing the Martell and the Roman methods in 112 total hip arthroplasties in patients 65 years and younger, with a mean follow-up of 5.7 years. The mean wear rates in the Martell and Roman methods were 0.014 ± 0.05 mm/y and 0.011 ± 0.04 mm/y when including all values and 0.043 ± 0.028 mm/y and 0.038 ± 0.02 mm/y when negative values were assumed to be zero, respectively. Both Roman and Martell methods showed similar low wear rates with negative values. The Roman method had higher precision and was more user friendly because it required less steps to measure wear, especially when comparing with the manual feature of Martell method.
Wear Analysis of Highly Cross-Linked Polyethylene in Total Hip Arthroplasty
Tribology in Total Hip Arthroplasty, 2011
Background: Highly cross-linked polyethylene was introduced for clinical use in total hip arthroplasty with the expectation that it would exhibit less wear when compared with conventional polyethylene. The purpose of this study was to report the clinical and radiographic results, after a minimum of five years of follow-up, of a randomized, blinded, controlled trial comparing a conventional polyethylene with a first-generation highly cross-linked polyethylene. Methods: One hundred patients were enrolled in a prospective, randomized controlled study comparing highly crosslinked and conventional polyethylene acetabular liners in total hip arthroplasty. Fifty patients were in each group. At the time of follow-up, clinical outcomes were assessed and steady-state femoral head penetration rates (after bedding-in) for each patient were calculated with use of a validated radiographic technique. In addition, a statistical comparison of polyethylene wear between groups was performed with use of generalized estimating equations. Results: At a mean of 6.8 years postoperatively, there were no differences between the two polyethylene groups with regard to the Harris hip score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), or Short Form-12 (SF-12) score. The mean femoral head penetration rate in the first through fifth years was found to be significantly lower in the group treated with the highly cross-linked polyethylene (0.003 mm/yr [95% confidence interval, ±0.027]) than it was in the group treated with conventional polyethylene (0.051 mm/yr [95% confidence interval, ±0.022]) (p = 0.006). Men treated with a conventional polyethylene liner had a significantly higher (p £ 0.012) femoral head penetration rate (0.081 mm/yr [95% confidence interval, ±0.065]) than both men and women with a highly cross-linked liner (20.013 mm/yr [95% confidence interval, ±0.074] and 0.009 mm/yr [95% confidence interval, ±0.028], respectively). The general estimating equations demonstrated that the group with a highly cross-linked polyethylene liner had a significantly lower femoral head penetration rate than the group with a conventional polyethylene liner (p = 0.025), and a significantly higher femoral head penetration rate was demonstrated in men with a conventional polyethylene liner when compared with both men and women with a highly cross-linked liner (p = 0.003). Conclusions: At a minimum of five years postoperatively, the steady-state femoral head penetration rate associated with this first-generation highly cross-linked polyethylene liner was significantly lower than that associated with a conventional polyethylene liner. Long-term follow-up is required to demonstrate the clinical benefit of this new material.
Clinical Orthopaedics and Related Research®, 2015
Background Highly crosslinked polyethylene (XLPE) was introduced to decrease periprosthetic osteolysis related to polyethylene wear, a major reason for revision of total hip arthroplasty. However, there are few reports of wear and osteolysis at 10 years postoperatively. Questions/purposes (1) What are the linear and volumetric wear rates of XLPE at 10 to 14 years? (2) What is the relationship among linear wear, volumetric wear, and femoral head size? (3) What proportion of hips developed osteolysis and was there a relationship between osteolysis and femoral head size or polyethylene wear?
Wear is Reduced in THA Performed with Highly Cross-linked Polyethylene
Clinical Orthopaedics and Related Research®, 2009
Highly cross-linked polyethylene (HCLPE) has been used extensively to decrease osteolysis and related implant failure in THA. We compared the wear rate of HCLPE and noncross-linked conventional PE (CPE) liners and the rate of radiographic calcar resorption and osteolysis in young patients (35-60 years of age) who underwent THA by one surgeon. Thirty-four patients (41 THAs) who received a hybrid THA using a HCLPE liner were matchpaired for age, gender, body mass index, and diagnosis with a group of patients who underwent THA with identical implants but with a CPE liner. The minimum followup was 4 years (average, 5.3; range, 4-8 years). Using the Livermore measurement technique, the averages of total wear of the HCLPE and CPE liners were 0.01 mm (range, -0.23-0.4) and 0.64 mm (range, 0-1.7), respectively. The average annual wear was less for the HCLPE than the noncross-linked PE (0.002 mm, range, -0.05-0.1 versus 0.12 mm, range, 0-0.29, respectively). Four hips in the HCLPE group and 23 in the CPE group had calcar resorption measuring averages of 2.5 mm (range, 2-3) and 7.5 mm (range, 1.8-23.8), respectively. Periprosthetic osteolysis occurred in two and eight hips in the HCLPE and CPE groups, respectively. Longer followup is needed to determine if these findings will result in improved implant survivorship.
Arthroplasty Today, 2021
Background: There is a paucity of data on the long-term performance of highly cross-linked polyethylene (HXLPE). Therefore, this study evaluated 10-year 1) functional, 2) radiographic, and 3) surgical outcomes in patients who underwent total hip arthroplasty with sequentially irradiated and annealed HXLPE. Methods: A retrospective, multicenter study was conducted on patients who underwent primary total hip arthroplasty and received HXLPE polymer (n ¼ 151). Two-dimensional radiographic linear and volumetric wear analyses were quantified using the Martell Hip Analysis software, while functional outcomes were assessed by analyzing postoperative Short-Form-12 (SF-12) Physical and Mental Health Surveys and Harris Hip Scores. Radiographic outcomes included yearly linear (mm/y) and volumetric (mm 3 /y) wear rates. Surgical outcomes included additional operations and survivorship. Results: SF-12 scores were within 1 standard deviation (SD) of the normal population (SF-12 Physical: 47.0; SF-12 Mental: 52.0), while the Harris Hip Scores of 89.5 was borderline between "good" and "excellent." Total and annual linear wear rates were 0.164 mm (SD: 0.199 mm) and 0.015 mm/y (SD: 0.018 mm/y), respectively. The mean total volumetric wear rate was 141.4 mm 3 (SD: 165.0) and 12.6 mm 3 /y (SD: 14.9 mm 3 /y) when broken down into a yearly rate. Eleven patients required revisions, resulting in an all-cause polyethylene survivorship of 92.7%, with a polyethylene wear survivorship of 100.0%. Conclusions: Our results demonstrate clinically undetectable linear and volumetric wear rates after 10 years in those who received the unique sequentially irradiated and annealed HXLPE. Furthermore, high rates of survivorship coupled with low all-cause revision rates illustrate the polymers' capability to potentially increase implant longevity.
The Journal of arthroplasty, 2018
The advent of highly cross-linked polyethylene (HCLPE) has significantly improved total hip arthroplasty survivorship. HCLPE has been shown to improve wear properties in midterm outcomes when compared to traditional polyethylene liners; however, there is a paucity of studies evaluating long-term outcomes. In addition, there is concern that wear rates may accelerate as the implant ages. Thus, the aims of this study are to report on the longest-to-date follow-up of a specific first-generation HCLPE liner and to determine whether there is a change in the annual wear rate over time. Forty hips in 38 patients which were previously reported on in a midterm study were included in this long-term follow-up study. Patients in this cohort all received total hip arthroplasty between March 1999 and August 2004 using the Crossfire HCLPE liner. Annual wear rates (mm/y) were calculated for this cohort. Patients were contacted and asked about complications or revision procedures they may have had si...
Reduction of Osteolysis with Use of Marathon Cross-Linked Polyethylene
The Journal of Bone and Joint Surgery-American Volume, 2008
We previously reported wear data at a minimum of two years following thirty-four total hip replacements with a Marathon cross-linked polyethylene liner and twenty-four replacements with a conventional (gamma-sterilized-in-air) Enduron polyethylene liner. In this current study, with sequential five-year radiographs, wear rates were determined with use of linear regression analysis. The Marathon polyethylene had average wear rates of 15.4 mm 3 /yr and 8.0 mm 3 / million cycles. The Enduron polyethylene had average wear rates of 55.5 mm 3 /yr and 29.9 mm 3 /million cycles. The adjusted volumetric wear rate of the Marathon polyethylene was 73% lower than that of the Enduron polyethylene (p = 0.001). Osteolysis developed in eight of the twenty-four hips with an Enduron liner but was not apparent in any hip with a Marathon liner.